Prognostic Factors for Survival in Adults With Burkitt Lymphoma: A Systematic Review

Abstract

Introduction

Burkitt lymphoma (BL) is a rare and aggressive subtype of non-Hodgkin's lymphoma. Several studies have identified prognostic factors (PFs) for disease progression and mortality among adults with BL. However, there is no consensus on risk stratification based on PFs. This study aims to identify, critically assess, and synthesize the available evidence on PFs for survival in adults with BL.

Methods

A systematic review was conducted. Medline, EMBASE, and CENTRAL were searched from inception to February 22, 2022. Randomized or non-randomized clinical trials and longitudinal observational studies were eligible for inclusion. Reference screening, data extraction, and risk-of-bias assessment were conducted independently and in duplicate. Publication bias was examined by visual inspection of funnel plots. Meta-analyses were conducted when appropriate using Review Manager 5. The certainty of evidence was assessed using GRADE.

Results

The search identified 1119 references. Of these, 76 papers were selected for full-text assessment and 36 studies (N = 10,882) reported in 39 articles were eligible for inclusion. Older age, higher performance status, and central nervous system involvement were associated with poorer overall survival (OS) and progression-free survival (PFS). Black patients exhibited significantly lower OS and relative survival. Bone marrow involvement and higher albumin levels were associated with poorer OS. Treatment with rituximab, and with methotrexate were associated with better OS and PFS.

Conclusion

This study provides a comprehensive and methodologically rigorous evidence review on PFs in adults with BL. Several significant associations of PFs and survival estimates were observed, therefore, providing data to inform treatment decisions and to improve patient care.